Provider Demographics
NPI:1417791815
Name:HOLWERDA, ANISA DANIELLE (MASTER SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:ANISA
Middle Name:DANIELLE
Last Name:HOLWERDA
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2408
Mailing Address - Country:US
Mailing Address - Phone:701-795-9143
Mailing Address - Fax:701-772-5560
Practice Address - Street 1:930 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2408
Practice Address - Country:US
Practice Address - Phone:701-795-9143
Practice Address - Fax:701-772-5560
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator